Eslami Ehsan, Barkhordar Hamid, Abramovitch Kenneth, Kim Jessica, Masoud Mohamed I
International Dentistry Program, School of Dentistry, Loma Linda University, Loma Linda, Calif.
Department of Developmental Biology, Harvard School of Dental Medicine, Boston, Mass.
Am J Orthod Dentofacial Orthop. 2017 Feb;151(2):248-258. doi: 10.1016/j.ajodo.2016.07.018.
We systematically reviewed observational, experimental, and diagnostic accuracy studies to assess the comparisons between cone-beam computed tomography (CBCT) and conventional radiography (CR) in the localization of maxillary impacted canines.
An open-ended electronic search of PubMed, Web of Science, ProQuest, and other databases for both published and unpublished articles up to May 2016 was performed. The reference lists of the included studies were screened. Two authors performed the searches with no language restrictions. The research questions were outlined based on a hierarchical model. The primary outcomes were diagnostic accuracy, level of intermodalities agreement, effect of these images on treatment planning and treatment outcomes, and societal efficacy between the CBCT and CR in the localization of impacted canines. Two reviewers evaluated the risk of bias assessment by using the Quality Assessment of Diagnostic Accuracy Studies tool and the Newcastle Ottawa Scale.
Eight studies met the inclusion criteria. Two studies reported diagnostic accuracy, 6 reported intermodalities agreement in impacted canine localization, and 3 reported treatment planning agreement between the modalities. No therapeutic and societal efficacy study found. The accuracy of CBCT ranged from 50% to 95%, and the accuracy of CR ranged from 39% to 85%. A wide range of kappa intermodalities agreement from 0.20 to 0.82, with observed agreement of 64% to 84%, was reported in canine localization. Broad kappa treatment planning agreement values from 0.36 to 0.72 were reported. Most studies suffered from a high risk of bias in subject selection.
The fair to moderate intermodalities agreement in maxillary canine localization might mean that the information obtained through these modalities is deviant and ultimately might affect treatment planning. Although there is still a lack of strong evidence, CBCT is more effective than CR in evaluating cases that are difficult to diagnose in the initial evaluation with CR.
No funding was received for this study.
我们系统回顾了观察性、实验性和诊断准确性研究，以评估锥形束计算机断层扫描（CBCT）与传统放射摄影（CR）在上颌埋伏尖牙定位方面的比较。
对PubMed、科学网、ProQuest及其他数据库进行不限语言的开放式电子检索，检索截至2016年5月的已发表和未发表文章。对纳入研究的参考文献列表进行筛选。两名作者进行检索，无语言限制。基于分层模型概述研究问题。主要结局为诊断准确性、不同成像方式间的一致性水平、这些影像对治疗计划和治疗结局的影响，以及CBCT和CR在上颌埋伏尖牙定位方面的社会效能。两名评审员使用诊断准确性研究质量评估工具和纽卡斯尔渥太华量表评估偏倚风险。
八项研究符合纳入标准。两项研究报告了诊断准确性，六项报告了在上颌埋伏尖牙定位方面不同成像方式间的一致性，三项报告了不同成像方式间在治疗计划方面的一致性。未发现治疗和社会效能研究。CBCT的准确性范围为50%至95%，CR的准确性范围为39%至85%。在上颌尖牙定位方面，不同成像方式间的kappa一致性范围较宽，为0.20至0.82，观察到的一致性为64%至84%。报告的治疗计划一致性kappa值范围较宽，为0.36至0.72。大多数研究在受试者选择方面存在较高的偏倚风险。
上颌尖牙定位方面不同成像方式间一致性一般至中等，这可能意味着通过这些成像方式获得的信息存在偏差，最终可能影响治疗计划。尽管仍缺乏有力证据，但在评估初始CR难以诊断的病例时，CBCT比CR更有效。
本研究未获得资金支持。
